The fight to end violence against women is both historic and universal. Historic, because gender inequality, which lies at the root of this violence, has been embedded in human history for centuries and the movement to end it challenges history, custom and, most critically, the status quo. Universal, because no society is an exception to the fact that violence against women is perpetrated through social and cultural norms that reinforce male-dominated power structures. The struggle is nothing less than a demand for full human rights to be unconditionally extended to all people everywhere.Those engaged in this struggle recognize that despite important advances that have laid the foundation for universal human rights, the work has only just begun. In October 2004, on the 25th anniversary of the landmark Convention on the Elimination of All Forms of Discrimination against Women, the committee monitoring international implementation stated, “In no country in the world has women’s full de jure and de facto equality been achieved.”

In most countries, in fact, the reality remains bleak. Discriminatory social norms and practices continue to impede women’s full enjoyment of their human rights. Insufficient political will, the extensive under representation of women in decision-making positions and a lack of resources to address the issue are further impediments to progress.

Asserting human rights

The Universal Declaration of Human Rights, adopted without dissent by the United Nations in 1948, recognizes the “equal and inalienable rights” of all people, “without distinction of any kind.” Violence against women contravenes a number of the fundamental human rights laid out in this Declaration such as the right to security of person; the right not to be held in slavery or subjected to inhuman treatment; the right to equal protection before the law; and the right to equality in marriage. Nevertheless, states sometimes deploy the argument of cultural relativism to defend practices that abuse women. According to the first United Nations Special Rapporteur on Violence against Women, “The universal standards of human rights are often denied full operation when it comes to the rights of women.”

This book highlights through written description and visual representation many of the persistent expressions of gender-based violence. The testimonies of women and girls emphasise that there is no room for complacency or a false sense of rapid progress in the fight against inequality. To the countless women still suffering today, any positive changes that have been achieved must bear little relevance to their immediate reality. Nevertheless, remarkable developments have taken place in recent years, due in large part to the commitment of a few to change the behavior of many. In the face of formidable forces maintaining the patriarchal systems that give rise to both discrimination and violence against women, there is evidence that the tide may be turning.

Custom, religious belief and, at the heart of these, the desire to maintain a woman’s purity by restraining her sexuality have prevailed over negative health effects of FGM to perpetuate the practice. A female circumcisor from Kenya explained that the ritual is a way to ensure purity and fidelity:

“When you cut a girl, you know she will remain pure until she gets, married, and that after marriage, she will be faithful. … But when you leave a girl uncut, she sleeps with any man in the community.”

While there is no definitive evidence documenting why or when FGM began, many theorize that it provided families a means to ensure virginity before marriage. Infibulation scars in particular form a “seal” that both guarantees and confirms a bride’s chastity, and even the less severe forms of FGM may diminish girls’ and women’s sexual desire, thus decreasing the likelihood of premarital relations.

Social control of women and girls remains a primary argument for FGM even today. According to a demographic and health researcher in Eritrea, the most common defence for FGM among survey respondents was that “Chastity is a woman’s only virtue and all measures have to be taken to maintain it. … Women have to be protected, and infibulation is the defense mechanism.” Chastity is not a universal goal, however. In some communities in Kenya, Uganda and select West African countries, a girl may be expected to produce a child before marriage to prove her fertility. If she successfully delivers a baby, she will then undergo FGM and be married. In these atypical examples, FGM is practiced on older girls and women.

Both men and women who embrace the practice say that FGM promotes cleanliness, attractiveness and good health. Implicit in their view is the perception that female genitalia are dirty, unsightly and, if left in their natural state, may breed disease or be susceptible to other maladies. The tradition also increase marriage ability. FGM is believed to confer a sense of general calm on its initiates and, insofar as it decreases sexual desire, to limit the risk of extramarital affairs. In the words of one tribal elder in Kenya, “A circumcised woman will choose a partner for love, not for sex.”

In some communities, in fact, FGM is a prerequisite to marriage. Failing to comply with the tradition may constitute grounds for divorce and/or forced excision. In others, bride price may be significantly lower for an uncircumcised woman. A smaller vaginal opening is thought to increase a husband’s sexual pleasure. Despite this, FGM cannot be assumed to be solely “male-driven”. Some men currently are acknowledging the negative impact of FGM and speaking out against it, even as societies of women continue to insist that FGM is a critical rite of passage for girls.

Practiced by followers of Christianity, Islam and traditional or animist faiths, as well as some Ethiopian Jews, FGM transcends religious belief. Nevertheless, and notwithstanding the fact that FGM predates Islam, research suggests that Muslims in particular associate FGM with sunnah, or “required practice”. In fact, clitoridectomy is referred to as “sunnah circumcision” in Arabic. Although most Islamic clerics actively discourage infibulation and an increasing number of imams are speaking out against any form of FGM, some maintain that lesser forms are acceptable. For example, one cleric from Ethiopia, speaking at a regional conference on female genital mutilation concluded, “This conference, and the medical research associated with it, does not show that the sunnah circumcision – cutting only the outer part of the clitoris – has caused any medical complications. … I believe that Islam condones the sunnah circumcision; it is acceptable.”

Across cultures, religions and continents, one common feature of the practice of FGM is the social conditioning of women and girls to accept and defend it. Longstanding traditions and social norms have ordained FGM as a social imperative that promotes the future wellbeing of girls. In most communities, song and poems are used to deride and taunt unexcised girls. Myths similarly help to ensure FGM’s perpetuation. In Nigeria, for example, some communities believe that if a baby’s head touches the clitoris during delivery, the infant will die. Community and family pressure to conform to traditional practices is great for both mothers and girls, and mothers are often the primary actors responsible for their ‘daughters’ mutilation. In the words of one mother who was interviewed at a refugee camp in Kenya, “The practice adds to a family’s prestige in the community. Who would not want to bring honour to her family?”

There are economic aspects to FGM as well. The practice is an important source of income for cicumcisors, who most often are female. In impoverished settings, the financial impetus can be strong. The social support of secret societies also can be compelling, as one 26-year-old female cicumcisor explained: “I was circumcised at 13 and have myself circumcised 23 girls since then. This is the only way I earn a living and feed my children. I was a school when my parents were killed – I had nobody to take care of me and entered the secret society. It was from there I got married.”

Response: from legislation to prevention

In the 1970s and 1980s, FGM gained international attention as a critical health issue for women and girls. As a result, women’s advocates have broadened the discourse surrounding FGM to include gendered considerations of women’s subordination and oppression, acknowledging FGM as a violation of internationally recognized human rights, including the rights to life, liberty and freedom from torture. Largely in response to the worldwide action of numerous local and international organizations, the WHO launched a 20-year-old plan in 1997 to accelerate the elimination of FGM. Since its inception, the WHO initiative has informed individual country plans to eradicate the practice.

Implicitly denounced in several international treaties and conventions that condemn harmful traditional practices, including the Convention on the Elimination of All Forms of Discrimination Against Women (1979), the Convention on the Rights of the Child (1989) and the African Charter on the Rights and Welfare of the Child (1990), FGM is explicitly condemned in the United Nations Declaration on the Elimination Against Violence Against Women (1993), the Declaration and Platform for Action of the Fourth World Conference on Women (1995) and the African Charter on Human and People’s Rights and its Protocol on Women’s Rights (2003).

Many Western countries receiving immigrants from settings where FGM is customary have passed laws forbidding the practice, including Australia, Belgium, Canada, Denmark, New Zealand, Norway, Spain, Sweden, the United Kingdom and the United States. France has used existing legislation to prosecute FGM cases.

Infibulation was outlawed in Sudan in 1946 and again following Sudan’s independence in 1956, but the 1993 penal code does not explicitly prohibit FGM. Nor do several other countries with a high prevalence of FGM have laws proscribing the practice, including Eritrea (95 percent prevalence), the Gambia (60 percent to 90 percent), Guinea Bissau (50 percent), Liberia (50 to 60 percent), Sierra Leone (90 percent) and Mali (90 percent). Although no laws in Mali prohibit FGM, the Ministry of Women, Children and Family has developed a national plan for eliminating the practice by the year 2007.

Despite progress in legislation, enforcement of anti-FGM laws in countries where they exist is often poor. Even more importantly, according to the president of the Research , Action and Information Network for the Bodily Integrity of Women (RAINBO), “Social change will not be attained through legal or punitive action alone.” Many experts argue that laws preventing FGM are valuable for underpinning education efforts and giving credibility to those working to eradicate harmful practices, but criminalizing FGM practitioners can inhibit critical discussion and encourage those involved to “go underground” in order to continue the practice, making an already dangerous procedure even more perilous.”

Synonymously identified as female genital cutting or female genital circumcision, “Female genital mutilation” broadly encompasses “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons.” Although many variations in procedures as well as terminology exist within and across the cultures where FGM is practiced, a standardized international classification for FGM was collaboratively developed in 1995 by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the United Nations Fund for the Populations Assistance (UNFPA).

The first method within the classification, commonly referred to as “clitoridectomy”, involves holding the clitoris of a girl child between thumb and index finger, pulling it out and then partially or fully amputating it with a swift stroke of a razor, knife or other inner surface of the outer lips of the vagina (labia majora) is also cut. The wound is then fused together with thorns, dung or other poultices, or stitches – a process that may be reinforced by tying together the girl’s legs for a period of up to six weeks. The resulting scar tissue typically covers the urethra and part or most of the vagina. A small hole is retained for the discharge of urine and menstrual blood. A fourth, “unclassified” type of FGM uncludes a wide range of harmful practices, from piercing or incising the clitoris to burning, scraping or introducing corrosive substances into the vagina.

While it is estimated that 85 percent of all FGM practices worldwide fall within the first two types, approximately 80 to 90 percent of girls in Dijibouti, Somalia and Sudan, as well as small percentages of girls in Chad, Egypt, Eritrea, Ethiopia, Gambia, Kenya, Mali, Nigeria and Tanzania undergo infibulation.

International debate regarding the appropriate terminology to describe FGM is almost as controversial as the practice itself. All official United Nations documents currently use the term “mutilation” to emphasize its medically gratuitous and severe nature. Many working on the ground, however, maintain that the term “cutting” is a more value-neutral and therefore respectful articulation of a practice to which many cultures and individuals remain committed. Others working both internationally and locally have used the term “circumcision”. While still popular idiomatically, the use of this term is diminishing in international discourse because its association to male circumcision (removing the foreskin of the penis) minim sizes the nature and effects of most types of genital cutting performed on women. Comparable genital “circumcision” for men would involve the partial or complete removal of the penis, in addition to the foreskin.

Although male circumcision is considered by some advocates to b a fundamental violation of a boy’s right to bodily integrity, its health impacts are currently the subject of heated discussion. Those opposed to male circumcision argue that it has negative impacts on men’s health and sexuality. Evidence also suggests that when performed in unhygienic settings male circumcision can lead to infections, injuries and even death. A recent study conducted in South Africa, however, concluded that circumcision may have positive effects for males in terms of reducing their risk of contracting HIV.

For females, the evidence is not similarly equivocal. Even the most minimal form of FGM can affect a girl’s normal sexual function and put her at risk of a wide spectrum of negative health consequences.

The health effects of FGM

The immediate physical effects of FGM may include severe pain, shock and hemorrhaging. There is also high risk of local and systemic infections, including abscesses, ulcers, delayed healing, septicaemia, tetanus and gangrene. Long-term physical complications may include urine retention and associated urinary-tract infections, obstruction of menses and related reproductive-tract infections, infertility, painful intercourse and prolonged and obstructed labor. FGM also can facilitate the transmission of HIV, especially if infected infants and girls are cut in group ceremonies were circumcisers use the same instrument on all the initiates. Even after it has healed, the scarred or dry vulva of an excised or infibulated woman can be torn easily during sexual intercourse, increasing the likelihood of HIV transmission by an infected partner.

In addition to a host of physical effects, the psychological terror of FGM may also have a lasting impact, including a sense for some girls of no longer having control over their bodies – especially if they are ambushed and forced to submit to the procedure. One young girl from Burkina Faso recalled what she initially thought was a casual visit to a relative’s house:

“They asked us to go around for sweets and eggs. When we arrived, three women caught me, bundled me in to the toilet, pinned me down and undressed me. … I saw the knife and knew what was going to happen. I cried out, but I couldn’t find the words to speak.”